There is a common question that I see pop up in EMDR Therapy message boards and networking groups, both from EMDR therapists and members of the general public: What about EMDR Therapy for Complex Trauma?
I often answer such a question, admittedly with some of my usual cynicism: What about it?
There is a growing tendency in the EMDR Therapy community to market special trainings, books, and programs to specifically address complex trauma, or complex PTSD. While I am not opposed to new ideas being shared, I am concerned by a tendency to conceptualize working with complex trauma using EMDR therapy as something new. And I say this as someone who once capitalized on the complex trauma angle myself in my own presentation of EMDR books and training, a history I will explore in this piece. EMDR Therapy has been used to successfully treat complex presentations of trauma since the early days of EMDR. I write this piece to shine a light on some of this historical context so that you may consider what it means for you as an EMDR therapist, especially if you are feeling the pressure to go out and get trained in every new thing on the market. If you are unfamiliar with the distinctions between post-traumatic stress disorder (PTSD) and complex PTSD, please consider reading this short primer article (which comes from a source other than myself) before proceeding.
One of the reasons I’ve never taken the “what about EMDR Therapy for complex trauma?” question too seriously is that all the way back in 2004 when I first presented for EMDR Therapy, I was that client with complex, relational trauma. And before you think, “But Jamie, you were so educated and well-resourced, you weren’t like our typically client,” for the record, I was not that well-resourced at the time. And I’d spend most days of my life from age 9 until showing up for EMDR in a state of chronic, suicidal ideation with some ventures into intent and plan.
My first EMDR therapist worked with me quite skillfully. She never made the complex nature of my trauma, or the dissociative disorder that she would correctly diagnose that resulted from it, seem like a big deal. She used what I would come to learn was the standard protocol in working with me, weaving in skillful resources and psychoeducation throughout. Now looking back, I see that she was a therapist who was well-grounded in her abilities and in herself. Who I was as a person as a result of my trauma did not scare her. To this day, I maintain that the quality she imparted was more about her capacity to sit with distress and be grounded in herself than it was a reflection of any specialty training.
As a new clinician, I proceeded to take basic training in 2005-2006 in the era before consultation was required by the EMDR International Association (EMDRIA) as a part of basic training. Nothing about what I was learning seemed contraindicated in working with complex trauma or dissociation. I admit that much of this confidence came from the lived experience of knowing how well that EMDR Therapy worked for me, a survivor of complex trauma with a diagnosed dissociative disorder. It was second nature to me that more stabilization resources, or in EMDR Therapy parlance, Phase 2 Preparation, would be needed and that adjustments or modifications would need to be made. More interweaves, cognitive and otherwise, would need to be used. The length of sets would need to be adjusted based on the client’s tolerance. A distancing technique or approach from another form of psychotherapy or wellness may need to be used. Not beginning reprocessing with a first or “touchstone” memory just seemed like common sense, opting instead for something that is more present-centered or lower impact. Even if those adjustments quickly opened up associative networks, the therapy participant would be in control of the entire experience, knowing that they had the agency to either stop, pause, or use a resource like a container. Or they could go with that, bringing in any resources for assistance that might be needed.
All of these suggestions were also right there in the core text for EMDRIA-approved trainings, EMDR Therapy: Basic Principles, Protocols, and Procedures by EMDR Therapy founder Dr. Francine Shapiro. Although now in its third edition (2018), I learned from the second edition (2001) and did not find it as restrictive as many others in the EMDR community made it out to be. Admittedly, some of Shapiro’s other language about things like fidelity to the protocol can be overwhelming in its tone and make these permissions for adaptation and artistry harder for new EMDR therapists to identify and to embrace.
The insistence on following the protocol at all costs by many EMDR Therapy trainers, consultants, and thought leaders may also be a culprit in tripping up new EMDR therapists. I cringe whenever I hear a phrase like “model drift” used in a shaming way towards those newer to EMDR. Hearing these things can make those newer to EMDR believe that they don’t have permission to modify or to put things like safety/stabilization, or the therapeutic relationship in the forefront.
As a long-time EMDRIA-Approved Trainer, I admit that, even though I am a natural modifier who has always accepted complex trauma as the norm in my clinical practice, the job of a basic trainer is to teach you the standard protocol. We have parameters prescribed by EMDRIA in which we have to work to teach you the protocol as Shapiro wrote it. I know implicitly that modifications and artistry will be needed in clinical practice in navigating more complex situations. I tried to infuse as much of these into my basic trainings as possible while also making sure my students know what they are modifying from. If you don’t learn what you are modifying from, you run the risk of doing sloppy EMDR that is not likely to fill you or your therapy participants with confidence.
In my early days as an EMDR therapist, turned off by some of the community’s insistence on the sacredness of the standard protocol in a way that set off my cult watch bells and whistles, I naturally got on the defensive about complex trauma. How could we honestly be therapists who are responsive to working with the most complex of cases when we are so bound up in a protocol that had only ever been researched, especially in the early days, for single incident PTSD?, I declared. And I declared it loudly in my first book, EMDR Made Simple: 4 Approaches to Using EMDR Therapy with Every Client (2011). I still look back on that book with a great deal of pride, especially now knowing that the Four Faces of EMDR Model that I introduced in it helped many lost EMDR clinicians feel liberated. Yes, I acknowledged trailblazers in the EMDR community like Deborah Korn, whose 2009 paper on using EMDR Therapy with complex trauma is a must-read, and Ricky Greenwald, whose 2007 book EMDR Therapy Within a Phase Model of Trauma-Informed Treatment gave us a template for better navigating complex trauma with EMDR Therapy. However, looking back, I can admit where I was a bit full of myself as the young EMDR therapist that I was when EMDR Made Simple came out, believing that I somehow held the key for better working with complex trauma and in training EMDR therapists for better addressing it.
What I gave in EMDR Made Simple and through my work with the Institute for Creative Mindfulness are some ideas in better appreciating and handling complex trauma presentations as the norm amongst our general client populations. They are just that: ideas in a sea of ideas that have long existed in the EMDR community from writers like Korn, Greenwald, Laurel Parnell, Jim Knipe, Robin Shapiro, Phillip Manfield, Sandra Paulsen, Katie O’Shea, and countless others who have not been afraid to share their innovations. And there are people working as consultants who have never written a book who can share ideas from the field with you that might be just as solid as anything you’d read in a book or take in a training. Even though I do fully implement the ideas of everyone I mentioned here, I still honor that they are a part of a natural community of innovators who have all helped to reach varieties of EMDR therapists and their clients.
If you are not someone who took to offering and modifying EMDR Therapy as naturally as I did, an ease that I credit to being a client for so long having started from a rather “complex” place, I recognize that you can come out of basic training feeling overwhelmed when you consider how to apply what you’ve learned in the real clinical world. You may be filled with fear that you will do more harm by training EMDR Therapy with your most vulnerable clients. You may run scared if you don’t know exactly what to do. So many of these problems in how we teach EMDR Therapy are institutional and organizational in nature. Not to mention the fact that the EMDR Therapy protocol is klunky (a word I use in EMDR Made Simple) and is not very intuitive if you haven’t had previous significant experience with it as a client working through your own complex trauma. I once thought there was a way I could better train EMDR Therapy for complex trauma while working within the parameters that EMDRIA sets for me. While I’ve tried my best over these last 12 years as a basic trainer, I know I’ve come up short and I’m glad that other ideas are being shared, especially for making EMDR Therapy more tolerable. My hope is that these ideas and innovations will appreciate the context and the history that came before them.
What I also hope you can recognize is that there is not one magic answer, either within EMDR Therapy or in other trauma therapies, for helping a person to fully heal the wounds of complex trauma. If you have not yet checked out the 2024 Guidelines of the American Psychological Association for Working with Adults with Complex Trauma Histories, I encourage you to do that. Although I am naturally skeptical of anything that APA puts out (and certainly have issues with their standard PTSD recommendations), the taskforce who wrote this paper did a great job of showing how there is no singular answer, especially any one modality, for working with trauma that is more complex and relational in nature. As I have long told my readers, watch how you are being marketed to with advanced topics and other specialty trainings, especially those that promise to give you certainty for working with complex trauma or any other presentation.
People have been addressing complex trauma using EMDR Therapy in clinical settings ever since it was developed. According to Dr. Robbie Dutton of The EMDR Institute, in a keynote delivered at the 2024 EMDR Humanitarian Assistance Programs (HAP) annual conference, one of the early people Dr. Shapiro worked with using EMDR was a person with dissociative identity disorder (DID). While we, as a community, have learned more about complex trauma and dissociation since those early days, what this anecdote shows me is that working with people that might seem too complicated is a part of EMDR Therapy’s history. Innovation is a part of EMDR Therapy’s history. As we continue to break new ground, may we be mindful of this context.
